[Reprinted  from  New  York  State  Journal  of  Medicine, 
July,  1913  ] 


THE  PROBLEM  OF  CARING  FOR  THE 
DEFECTIVES.* 

By  WILLIAM  T.  SHANAHAN,  M.D., 

SONYEA,  N.  Y. 

This  article  is  intended  simply  as  a  brief 
conservative  summary  of  the  subject  of 
defectiveness  and  degeneracy  in  general 
with  a  broad  outline  of  treatment  and  not  as 
•an  exhaustive  treatise.  It  is  presented  as  a  plea 
to  endeavor  to  prevent  some  defectiveness  at  its 
source  rather  than  waiting  helplessly  to  care 
for  the  end  product. 

Feeblemindness  may  be  defined  as  a  mental 
state  which  has  never  reached  the  normal  level. 
Insanity,  on  the  contrary,  is  a  mental  state  which 
has  changed  as  the  result  of  various  influences 
acting  upon  it  so  that  the  individual  thus  afflicted 
feels,  thinks  and  acts  in  an  abnormal  manner. 
Epilepsy  is  a  chronic  progressive  disorder  char¬ 
acterized  by  recurrent  abrupt  attacks  of  loss  or 
impairment  of  consciousness  with  or  without 
convulsions,  and  as  a  rule,  accompanied  by  men¬ 
tal  and  ofttimes  physical  deterioration.  These 
three  conditions  as  well  as  inebriety,  criminalis¬ 
tic  tendencies,  vagrancy,  prostitution  and  pau¬ 
perism  frequently  go  hand  in  hand  in  members 
of  the  same  family.  Many  of  these  states  have 

*  Read  before  the  Medical  Society  of  the  County  of  Allegany, 
at  Cuba,  April  10,  1913. 


been  recognized  since  a  remote  period  in  the 
world’s  history,  but  only  recently  has  there 
arisen  a  due  recognition  of  the  importance  of 
their  influence  upon  the  social  world. 

Persons  who  have  given  much  study  to  the 
matter  have  arrived  at  the  conclusion  that  from 
two  or  three  per  cent,  of  the  general  population 
in  this  country  are  defective  or  disordered  men¬ 
tally.  Taking  the  lowest  percentage  mentioned, 
you  can  realize  that  in  the  State  of  New  York 
this  would  mean  that  at  least  200,000  persons 
.are  unfit  to  assume  a  normal  place  in  the  com¬ 
munity.  It  has  been  determined  that  30  per 
cent,  or  more,  of  the  inmates  of  our  various  re¬ 
formatories  and  prisons  are  mentally  defective. 
What  a  farce  it  is  to  attempt  to  reform  an  in¬ 
dividual  who  is  absolutely  irresponsible  in  con¬ 
sequence  of  a  mental  impairment,  the  result 
either  of  an  incomplete  development  of  his  brain 
•or  the  destruction  of  a  portion  of  the  brain  es¬ 
sential  for  a  normal  development. 

Rosanofif  and  Orr  state  that  it  has  been  esti¬ 
mated  that  about  30  per  cent,  of  the  general 
population,  without  being  actually  neuropathic, 
carry  the  neuropathic  taint  from  their  ancestors 
and  are  capable  under  certain  conditions  of 
transmitting  this  taint  to  their  progeny. 

Conservative  estimates  made  in  England  give 
the  proportion  of  feebleminded  as  i  to  248  of 
the  general  population  and  of  insane  i  to  273 
of  the  general  population.  In  the  United  States 
the  proportion  in  all  probability  does  not  differ 
materially  from  that  in  England,  although  one 
must  ever  bear  in  mind  that  the  personal  equa¬ 
tion  of  the  individual  compiling  statistics  has  to 
be  given  consideration.  In  consequence  of  this 
personal  equation  entering  into  this  matter,  sta- 


.V 


2 


•  SC.'?''  '2> 

Sh  \ 

tistics,  as  you  know,  sometimes  vary  to  a  marked' 
extent.  Allowing  however,  for  this  variability 
and  considering  the  subject  from  a  most  con¬ 
servative  viewpoint,  one  must  realize  that  in 
his  own  community  at  least  one  to  every  three 
hundred  members  of  that  community  is  defec¬ 
tive  and  that  if  tests  could  be  applied  to  every 
member  of  the  community  there  would  be  found 
a  much  larger  proportion  than  that  given.  Pause 
for  a  moment  and  think  what  this  defectiveness 
means  in  the  relations  of  such  individuals  with 
those  about  them. 

This  large  number  of  defectives  in  our  midst 
brings  up  the  question  as  to  how  many  annually 
grain  entrance  to  the  country  as  immigrants.  Any 
one  wno  has  visited  Ellis  Island,  the  principal 
gateway,  and  witnessed  several  thousand  immi¬ 
grants  pass  inspection  in  one  day  must  realize 
that  with  the  meager  opportunities  afforded  for 
properly  examining  these  immigrants  a  very 
considerable  number  of  feebleminded,  epileptic, 
insane,  criminals,  etc.,  enter  undetected,  and 
New  York  State  has  to  ultimately  care  for  a 
large  proportion  of  them. 

In  1912,  there  were  in  the  state  and  private 
hospitals  for  the  insane  in  New  York  State  over 
34,000  patients,  in  the  institutions  for  feeble¬ 
minded  and  epileptic  6,000,  and  in  the  various 
prisons,  jails,  reformatories  over  14,000,  making 
in  all  over  54,000.  Allowing  that  there  are  200,- 
000  defectives  in  the  state,  one  naturally  asks 
where  are  the  other  146,000  and  what  are  they 
doing.  It  is  true  that*  some  of  the  remainder 
are  fortunate  enough  to  have  relatives  who  give 
them  careful  oversight,  protecting  them  from 
themselves  and  from  the  community  and  also 
protecting  the  community  from  their  irresponsi- 

3 


V 


bie  acts.  Unfortunately,  however,  the  major¬ 
ity  of  such  defectives  are  not  under  the  careful 
supervision  of  their  family  or  an  institution,  but 
are  permitted  to  follow  their  own  inclinations 
and  as  a  rule,  sooner  or  later,  get  into  various 
difficulties,  many  of  them  exceedingly  serious  in 
nature,  not  only  for  themselves,  but  for  those 
about  them.  Furthermore,  one  must  ever  bear 
in  mind  that  these  defectives  are  found  in  all 
races  and  among  all  classes  of  people,  in  the 
rural  and  urban  community,  at  all  ages  and 
among  the  rich  as  well  as  the  poor. 

Fomierly  there  was  a  certain  amount  of  con¬ 
fusion  as  the  result  of  various  terms  applied  to 
feeblemindedness  and  its  different  degrees.  In 
consequence  of  this  a  few  years  ago  those  work¬ 
ing  with  the  feebleminded  in  America  decided 
upon  a  new  classification,  using  the  general  term 
feebleminded  to  include  all  of  those  individuals 
who  had  never  reached  the  normal  stage  of 
mental  development  for  their  physical  age,  and 
making  as  subdivisions  morons,  imbeciles  and 
idiots.  The  idiot  may  be  defined  as  an  indi¬ 
vidual  who  has  never  passed  beyond  the  mental 
age  of  tw’O  years,  and  in  consequence,  is  unable 
to  protect  himself  from  ordinary  dangers  or 
care  for  himself,  the  imbecile  one  who  has  never 
developed  beyond  the  mental  age  of  seven  years, 
and  consequently  unable  to  gain  a  living,  the 
moron  one  who  has  reached  a  mental  develop¬ 
ment  corresponding  with  a  child  from  seven  to 
12  years  of  age  mentally,  and  who  can  under  the 
most  favorable  conditions  maintain  himself,  but 
has  not  the  stability  of  a  normal  adult. 

Among  those  who  apparently  are  of  the  men¬ 
tal  age  of  twelve  years  or  thereabouts,  it  is  very 
apparent  that  there  are  a  considerable  number 


4 


who  approach  closely  the  margin  of  a  normal 
mental  state  but  who  could  not  be  called  nor¬ 
mal,  and  to  such  the  term  borderland  or  border¬ 
line  cases  would  apply. 

To  further  characterize  and  distinguish  par¬ 
ticular  classes  of  the  feebleminded,  special  ref- 
'crence  to  some  physical  defect  or  other  accom¬ 
panying  condition  has  been  made  use  of,  e.  g. 
Mongolian  imbecile,  meaning  an  individual  who 
is  mentally  between  the  age  of  two  and  seven 
years  and  who  shows  the  characteristic  signs  of 
^  broad-fissured  tongue,  obliquely-placed  eyes, 
a  short  little  finger ;  the  epileptic  idiot,  or  im¬ 
becile  or  moron  being  one  in  whom  the  symp¬ 
toms  of  epilepsy  are  present  as  well  as  the  state 
of  mental  defectiveness ;  the  microcephalic  idiot 
is  one  with  a  small  head,  and  macrocephalic  one 
with  a  large  head,  etc. 

Congenital  feeblemindedness  as  differentiated 
from  acquired  feeblemindedness  are  terms  self- 
explanatory.  The  cretin  is  an  individual  in 
whom  there  is  a  faulty  development  because  of 
an  insufficient  functioning  of  the  thyroid  gland 
beyond  the  stage  usually  found  in  the  very  young 
child. 

The  epileptics  may  be  subdivided  into  that 
appearing  in  early  life,  including  over  8o  per 
cent,  of  all  such  patients,  and  that  appearing 
late  in  life;  the  idiopathic  or  the  class  in  whom 
the  cause  cannot  be  ascertained ;  classified  as  to 
seizures,  the  grand  mal  or  severe,  the  petit  mal 
or  mild,  the  complete,  the  incomplete,  the  abor¬ 
tive,  the  Jacksonian  in  which  type  the  convul¬ 
sions  are  not  accompanied  by  loss  of  conscious- 
nes*s;  the  psychic  in  whom  there  is  a  distur¬ 
bance  of  the  mind  without  the  accompanying 
convulsions,  etc.  There  may  be  any  degree  of 


^combinations  of  these  various  types  of  epilepsy, 
these  combinations  varying  from  time  to  time, 
depending  on  the  type  of  seizures  to  which  epi¬ 
leptic  may  be  subject.  Those  who  have  had  ex¬ 
perience  are  agreed  that  these  varieties  are  al¬ 
most  endless.  The  classification  of  insanity  and 
its  symptomatology  cannot  be  referred  to  in  a 
paper  of  this  kind  as  time  will  not  permit. 

It  must  be  remembered  in  connection  with  al¬ 
coholism  that  persons  are  difl'erently  constitu¬ 
ted  in  regard  to  the  effect  that  alcohol  produces 
on  them.  One  person  may  with  seeming  im¬ 
punity  consume  large  quantities  of  alcohol  over 
a  period  of  many  years  without  apparent  serious 
results.  In  another  person,  appearing  to  be 
quite  healthy,  the  continued  use  of  a  quantit}’ 
of  alcohol  exhibits  a  marked  deleterious  effect. 
It  has  been  advanced  by  students  of  the  sub¬ 
ject  that  the  majority  of  inebriates  are  iiot  such 
solely  from  the  use  of  the  alcohol,  but  are  pre¬ 
disposed  as  the  result  of  a  hereditary  mental  de¬ 
fect  to  become  victims  of  the  alcoholic  habit. 
Without  going  into  the  symptoms  of  chronic 
alcoholism  in  detail,  I  would  state,  that  there  is 
a  dulling  of  the  mental  faculties  of  the  individual 
and  accompanying  this,  there  is  naturally  a 
marked  lowering  of  the  moral  tone,  so  that  such 
persons  become  more  or  less  irresponsible  for 
their  actions  and  are  not  to  be  relied  upon. 
Eventually  many  of  them  suffer  such  a  marked 
degree  of  mental  impairment  that  it  becomes 
necessary  to  place  them  under  close  and  con¬ 
stant  supervision. 

It  is  the  rule  of  human  life  to  have  the  nor¬ 
mal  individual  develop  until  a  complete  stage  is 
reached,  at  about  the  age  of  thirty  years  and 
.almost  immediately  thereafter  a  gradual  decline 


6 


to  begin,  this  decline  progressing  steadily  for 
three  or  four  decades  without  producing  any  un¬ 
toward  symptoms.  In  certain  abnormal  or  de¬ 
fective  people  this  normal  stage  of  involution 
brings  about  the  appearance  of  certain  symp¬ 
toms,  among  which  are  those  perhaps  of  a  dis¬ 
turbed  mental  state,  or  perhaps  convulsive  at¬ 
tacks. 

Another  class  of  people  somewhat  along  this 
same  line  are  those  in  whom  what  might  be 
termed  normal  senile  changes,  instead  of  grad¬ 
ually  occurring  and  bringing  about  a  readjust¬ 
ment  of  the  individual’s  general  condition  at  the 
usual  period  in  life,  appear  much  earlier  than 
in  the  normal  individual. 

The  causes  of  degeneracy  are  many  diverse 
deleterious  influences  occuring  in  the  antenatal 
or  the  postnatal  period,  or  in  both.  These 
causes  may  be  divided  into  those  which  pave 
the  way,  but  in  themselves,  may  not  bring  to 
light  the  defective  state,  these  being  known  as 
predisposing  and  added  to  these  potential  fac¬ 
tors  are  what  are  known  as  exciting  factors, 
that  is,  causes  which  affect  the  individual  in 
such  a  manner  as  to  bring  to  light  the  symptoms 
of  the  defective  condition.  What  in  one  person 
may  be  a  predisposing  cause  may  in  another  be 
an  exciting  cause,  and  again  a  predisposing 
cause  long  continued  may  eventually  act  as  an 
exciting  cause. 

Among  the  active  predisposing  causes  is  one, 
which  has  much  greater  influence  than  is  ordi¬ 
narily  thought  for  by  the  layman,  and  upon 
which  I  wish  to  lay  as  much  stress  as  is  possi¬ 
ble,  and  that  is  heredity.  Among  the  conditions 
presented  in  ancestors,  which  seem  especially  to 
influence  the  descendants  are  feeblemindedness,. 


# 


7 


insanity,  alcoholism,  epilepsy,  syphilis,  etc.  Nu¬ 
merous  theories  have  been  evolved,  especially 
in  recent  years,  in  regard  to  the  laws  of  heredity. 
Some  fifty  years  ago  Gregor  Mendel,  a  monk 
in  Austl'ia,  made  certain  experiments  with  peas 
and  traced  out  through  many  generations  the 
appearance  of  color,  height,  etc.  Of  recent 
years  it  has  been  found  that  apparently  so  far 
as  studies  have  gone  that  some  of  these  Mendcl- 
ian  laws  may  apply  to  the  human  family. 

The  cell  from  which  the  human  individual  de¬ 
velops  is  made  up  of  two  parts,  the  germ  cell 
which  has  to  do  with  the  carrying  on  of  the 
race,  and  the  soma  which  has  to  do  with  the 
development  of  the  particular  individual  of  the 
race.  At  the  present  day,  it  is  thought  by  many 
that  the  germ  cell  is  passed  on  from  one  in¬ 
dividual  to  its  ofifspring  and  so  on  indefinitely 
through  succeeding  generations  without  change,. 
acquired  characteristics  in  an  individual  not  be¬ 
ing  transmitted  to  the  offspring.  Many  eminent 
authorities  do  not  agree  with  this,  but  maintain 
that  there  are  certain  influences,  e.  g.  alcohol  and 
syphilis,  which  may  affect  the  germ  plasm  so- 
that  in  the  succeeding  generation  its  deleterious 
effects  may  be  observed  as  a  state  of  defective¬ 
ness. 

Most  writers  agree  that  the  soma  which  de¬ 
velops  into  the  body  of  an  individual  member 
of  any  one  generation  may  as  the  result  of  nu¬ 
merous  influences  acting  upon  it  vary  in  its  de¬ 
velopment.  It  should  be  borne  in  mind  that  a 
defect  in  one  generation  does  not  necessarily 
imply  that  the  defect  in  the  preceding  genera¬ 
tion  was  exactly  the  same,  there  being  appar¬ 
ently  an  interchange  in  a  way  between  insanity,. 


8 


feeblemindedness,  epilepsy,  etc.,  so  that  one  de* 
feet  may  be,  as  it  were,  substituted  for  another. 

Our  present  knowledge  of  heredity  would 
lead  one  to  feel  that  in  the  feebleminded  and 
epileptic  there  is  lacking  some  element  which 
must  be  present  in  the  normal  individual  to 
bring  about  a  normal  state  of  development. 

It  is  evident  to  honest  students  of  heredity 
that  longer  continued  study  is  required  before 
enough  accurate  facts  can  be  presented  to  sup¬ 
port  what  is  now  partly  theory.  The  offspring 
of  a  union  of  two  plainly  mentally  defective 
persons  is  probably  always  mentally  defective, 
but  when  one  parent  is  healthy  and  of  good 
stock,  or  both  parents  are  healthy  but  of  neu¬ 
ropathic  stock,  etc.,  there  must  be  much  further 
investigation  made  before  what  are  now  but  the¬ 
ories  can  be  recognized  as  laws  governing  here¬ 
dity. 

Just  at  this  point  I  wish  to  impress  upon  you 
the  fact  that  if  the  family  stock  is  healthy  the 
offspring  from  a  consanguineous  marriage  will 
be  healthy,  if  the  stock  is  tainted  the  defect 
will  be  intensified. 

In  ascertaining  facts  in  regard  to  defective 
individuals  and  their  families,  it  is  of  the  utmost 
importance  to  have  trained  field  workers,  pre¬ 
ferably  carefully  selected  physicians,  persons 
who  can  visit  the  community  in  which  the  af¬ 
flicted  person  resides  and  there  investigate  all 
facts  in  regard  to  the  personal  and  family  his¬ 
tory  of  the  person  concerned,  making  inquiry 
not  only  of  the  members  of  the  family  but  also 
of  their  physician,  clergyman  and  any  other 
persons  who  may  be  interested  or  have  any 
knowledge  of  conditions.  These  trained  inves¬ 
tigators  should  obtain  much  valuable  data,  sift- 


9 


ing  the  actual  facts  from  the  alleged  or  coin¬ 
cidental  factors  in  each  particular  instance,  and 
can  also  disseminate  through  the  community  in 
^  which  they  work  practical  information  relating 
to  the  problem  under  discussion. 

With  regard  to  the  outcome  of  these  various 
conditions,  it  must  be  confessed  that  with  most 
defectives  one  can  not  look  for  more  than  a 
general  improvement.  In  some,  e.  g.  certain 
types  of  insanity,  there  is  apparently  a  recovery, 
which  proves  more  or  less  permanent.  In  others, 
some  epileptics,  many  of  the  insane,  inebriates, 
etc.,  there  may  be  an  arrest  of  the  symptoms  with 
a  recurrence  later.  With  the  feebleminded  and 
'the  great  majority  of  the  epileptic  and  a  consid¬ 
erable  number  of  the  insane,  no  hope  can  be 
held  forth  to  bring  about  a  restoration  to  normal 
health  as  in  these  persons  there  is  a  congenital 
defect  or  there  has  been  an  actual  destruction  of 
some  essential  parts  of  the  brain  structure, 
which  cannot  be  replaced  by  any  work  of  repair 
such  as  occurs  in  some  of  the  simpler  tissues  of 
the  body.  Many  of  the  insane  are  discharged 
from  hospitals  as  recovered,  but  later  have  a  re- 
'currence  of  their  symptoms  and  have  to  be  re¬ 
committed. 

By  removing  certain  exciting  factors,  either 
mental,  physical  or  both  and  making  the  indiv¬ 
idual  live  as  simple  a  life  as  possible,  there  may 
result  a  marked  improvement  in  the  health  of 
many  of  the  defectives.  Dietary  and  other  ex¬ 
cesses,  the  strenuous  life  of  modern  civilization 
often  with  improper  environment,  etc.,  are  con¬ 
ditions  which  must  be  given  earnest  and  active 
consideration. 

Among  a  considerable  proportion  of  the  insane, 
the  epileptic  and  others,  there  is  undoubtedly  a 


lO 


disturbance  of  the  normal  relation  between  vari¬ 
ous  internal  secreting  glandsy  e.  g.  the  pituitary 
body,  the  thyroid  gland,  the  supra-renal  bodies, 
the  pancreas,  etc.,  this  resulting  in  a  chemical 
unbalance  and  in  consequence  symptoms  of  the 
disorder  appear. 

In  all  of  these  persons,  but  especially  in  the 
insane  and  epileptic,  there  is  an  unstable  ner¬ 
vous  system,  which  cannot  withstand  certain 
influences  as  can  a  normal  nervous  system. 

The  actual  cause  of  many  of  the  symptoms 
occurring  in  many  defectives,  such  as  convul¬ 
sions,  periods  of  excitement,  depressions,  etc., 
are  found  to  be  due  apparently  to  causes  beyond 
discovery  by  our  present  methods  of  research 
and  in  consequence  are  often  alleged  to  be  due 
to  certain  causes  which  are  not  the  actual  causes 
but  are  purely  coincidental. 

There  is  no  question  but  what  if  the  functions 
of  the  gastro-intestinal  tract,  e.  g.  digestion  and 
absorption,  are  imperfect  that  the  effect  pro¬ 
duced  upon  persons  with  unstable  nervous  sys¬ 
tems  is  exceedingly  far  reaching.  The  influence 
of  teething  as  an  exciting  factor  in  the  epileptic 
has  in  my  opinion  been  greatly  overdrawn  as 
this  is  a  purely  natural  process  which  all  of  the 
human  race  must  experience.  What  is  true  is 
that  during  the  age  when  the  first  dentition 
occurs  the  delicate  nervous  system  is  more  sen¬ 
sitive  to  various  stimuli  than  later  in  life. 

The  abuse  of  alcohol,  the  injuries  to  the  brain 
after  birth,  and  injuries  during  birth,  paralysis 
consequent  upon  encephalitis  occurring  in  in¬ 
fancy  or  early  childhood,  syphilis,  the  various 
infectious  diseases,  such  as  scarlet  fever,  meas¬ 
les,  whooping  cough,  etc.,  which  may  be  com¬ 
plicated  by  meningitis  or  an  inflammation  of  the 


I 


brain  substance  itself,  hemorrhages  into  the 
brain,  arterio-sclerosis  appearing  early  or  being 
unduly  marked  produce  a  more  or  less  severe 
disturbance  of  nutrition  or  actual  destruction  of 
some  of  the  essential  structures  of  the  central 
nervous  system.  The  male  sex  in  adult  years 
are  more  subject  to  the  abuse  of  alcohol,  in¬ 
fection  with  syphilis,  the  receipt  of  severe  in¬ 
juries  to  the  head,  etc.,  which  factors  must  be 
considered  in  making  any  statement  in  regard 
to  the  probable  outcome  in  any  particular  case. 

Feeblemindedness  is  largely  due  to  congenital 
causes  or  the  result  of  certain  conditions  occur¬ 
ring  in  early  life.  Epilepsy  is  also  a  disorder  of 
early  life,  the  onset  in  8o  per  cent,  of  such  in¬ 
dividuals  occurring  before  20  years  of  age.  In¬ 
sanity  on  the  contrary,  as  a  rule,  does  not  make 
itself  apparent  before  the  early  adult  years  and 
in  certain  types  not  until  the  individual  is  well 
advanced  in  years.  This  means  the  insane  have 
as  a  rule  the  opportunity  of  securing  some  edu¬ 
cation,  learning  a  trade,  etc.,  whereas  the  feeble- 
minded  and  epileptic  are  frequently  deprived  of 
such  advantages. 

All  defectives  have  present,  to  a  greater  or 
lesser  extent,  various  malformations  known  as 
stigmata  of  degeneracy.  These  alone  do  not 
have  a  very  important  bearing  on  the  state  of 
the  person  under  consideration,  unless  associa¬ 
ted  with  other  symptoms,  both  mental  and  phy¬ 
sical.  It  is  a  question  as  to  whether  any  individ¬ 
ual  is  absolutely  perfect,  depending  upon  what 
is-  recognized  as  a  normal  standard. 

The  various  physical  deviations  from  the  nor¬ 
mal  average  seen  in  the  different  types  of  defec¬ 
tives  are  not  peculiar  to  these  individuals,  except 
to  show  that  these  persons  are  not  of  a  normal 


12 


physical  make  up,  but  have  a  fundamental  de¬ 
fect.  The  various  injuries  received  by  epilep¬ 
tics  during  seizures  result  in  scars  and  deformi¬ 
ties  in  different  parts  of  the  body.  Paralysis, 
especially  when  occurring  in  early  life,  interfere 
markedly  with  the  development  of  the  parts 
involved. 

After  death,  examinations  made  of  the  vari¬ 
ous  structures  show  that  in  many  there  are  ab¬ 
normal  conditions  apparent  to  the  naked  eye, 
such  as  defects  in  the  structure  of  the  brain, 
changes  in  the  heart,  especially  in  the  valves, 
while  microscopically  there  are  found,  numerous 
destructive  changes  in  the  essential  cells  mak¬ 
ing  up  the  central  nervous  system  and  of  many 
of  the  internal  organs,  especially  the  kidney. 

In  those  mentally  afflicted  certain  symptoms 
are  observed,  e.  g.  hallucinations,  which  are 
sense  perceptions  without  external  stimulation ; 
illusions  or  perverted  sense  perceptions  and  de¬ 
lusions,  false  ideas  which  may  arise  from  hallu¬ 
cinations,  illusions  or  other  delusions ;  states  of 
depression  or  excitement  are  common  conditions 
but  which  are  much  more  marked  than  similar 
states  in  the  ordinary  individual;  disorientation 
or  an  inability  of  the  individual  to  locate  himself 
either  to  time  or  place;  retardation  of  the  men¬ 
tal  processes  where  the  activity  of  the  mind  is 
much  slower  than  in  the  normal  person ;  flight 
of  ideas  where  the  individual  changes  from  one 
subject  to  another  without  having  apparently 
any  definite  purpose  in  view,  his  ideas  not  being 
in  an  orderly  arrangement  as  in  the  normal  per¬ 
son  ;  stupor  which  may  be  slight  in  degree  or 
most  profound ;  impulsions  and  compulsions 
which  seemingly  take  hold  of  the  individual  and 
force  him  to  follow  out  what  these  ideas  sug- 


13 


gest;  amnesia  or  a  loss  of  memory  of  what  has 
transpired  during  a  given  period  of  time,  etc. 

Dementia,  a  term  often  used  incorrectly  by  the 
layman  to  characterize  any  acute  mental  upset, 
is  a  permanent  impairment  of  the  mind  and  may 
advance  to  such  a  degree  as  to  make  an  individ¬ 
ual  who  has  once  been  exceedingly  intelligent 
pass  into  condition  where  he  has  to  be  cared  for 
like  a  new  born  child. 

In  epilepsy  there  may  be  seen  convulsive  seiz¬ 
ures  with  loss  of  consciousness,  biting  of  the 
tongue,  passing  of  the  urine  and  the  receipt  of 
various  injuries  as  the  result  of  falls  during 
these  convulsions.  There  are  milder  seizures  in 
which  there  may  be  no,  or  but  slight,  convulsive 
movements  and  a  very  transitory  loss  or  impair¬ 
ment  of  consciousness.  In  epilepsy  there  may 
be  acute  attacks  of  mental  confusion  or  excite¬ 
ment,  perhaps  to  the  extent  of  violence  during 
which  the  individual  may  assault  those  about 
him  especially  if  interfered  with  in  any  manner. 
Some  of  these  periods,  often  not  recognized  as 
epileptic  in  nature,  are  known  as  automatism 
and  follow  the  mild  seizure,  being  in  fact  a  part 
of  the  same  but  there  are  other  mental  attacks 
which  seem  to  occur  independently  of  any  con¬ 
vulsive  seizure,  and  are  then  known  as  psychic 
seizures  or  equivalents  and  may  last  for  days 
or  weeks. 

The  natural  tendency  for  the  epileptic  in  con¬ 
sequence  of  a  progressive  destructive  process 
existing  in  the  brain  is  toward  a  gradual  mental 
deterioration,  which  in  some  continues  to  most 
profound  dementia  and  in  others  is  held  in  abey¬ 
ance,  perhaps  for  a  long  period  of  years. 

Some  epileptics  are  apparently  very  religious, 
but  do  not  carry  out  in  practice  what  they  pre- 


14 


tend  to  believe  and  talk  about.  Irritability  and 
a  tendency  toward  fault  finding  is  a  common 
characteristic  of  the  epileptic.  A  loss  of  mem¬ 
ory  for  the  period  of  the  attack  be  it  convulsive 
or  psychic  is  the  rule  in  the  epileptic. 

Unrecognized  epilepsy,  especially  that  of  the 
mild  type,  results  in  great  danger  to  not  only  the 
individual  but  to  the  community  in  which  he  re¬ 
sides,  e.  g.,  when  this  condition  is  present  in  mo- 
tormen,  engineers,  chauffeurs,  barbers,  etc.  A 
considerable  percentage  of  the  feebleminded 
have  convulsions  in  some  period  of  their  exis¬ 
tence  ;  these  then  cease  and  do  not  recur. 

The  feebleminded  person  has  been  referred 
to  as  an  unfinished  individual,  whose  mental  state 
has  never  reached  the  normal,  while  the  insane 
have  been  described  as  people  who  have  once 
been  rich  and  are  now  poor.  The  feebleminded 
person  might  be  termed  a  person  who  has  al¬ 
ways  been  poor  so  far  as  his  mental  equipment 
has  been  concerned. 

Many  children  are ‘backward  and  retarded  be¬ 
cause  of  lack  of  opportunity  for  receiving  an 
education  because  of  some  serious  illness,  often 
occurring  in  early  childhood,  extending  over  a 
considerable  period  of  time  and  also  where  one 
or  more  of  the  special  senses  are  markedly  im¬ 
paired  or  entirely  absent,  e.  g.  loss  of  vision, 
hearing  and  speech. 

As  a  result  of  the  careful  examination  of  the 
mental  state  of  several  thousand  school  children, 
certain  tests  to  establish  the  mental  age  have 
been  elaborated,  known  as  the  Binet-Simon  tests. 
These  tests  when  used  properly,  bearing  in  mind 
the  environment,  nationality,  etc.,  of  the  child  or 
adult  being  tested  and  having  the  individual  at 
ease  are  of  great  value  in  determining  the  men- 


15 


tal  age  of  any  particular  person.  The  illustra¬ 
tions  accompanying  this  article  show  the  actual 
and  the  mental  age  of  several  of  the  higher 
grade  of  the  feebleminded  and  demonstrate  how 
such  persons’  mentality  does  not  always  express 
itself  so  as  to  be  recognized  at  its  proper  value 
by  the  ordinary  observer. 

The  term  for  feeblemindness  commonly  used 
in  England,  amentia,  explains  itself  as  being 
something  different  from  dementia  so  far  as  the 
actual  state  is  concerned.  These  conditions  may 
ultimately  be  much  the  same  but  in  amentia  the 
individual  has  always  been  below  the  normal 
state  whereas  the  dement  has  ordinarily  had 
this  state  but  has  lost  it.  The  feebleminded 
may,  however,  and  do  dement. 

Those  who  have  had  the  opportunity  of  observ¬ 
ing  defectives  and  degenerates  have  arrived  at 
the  opinion  that  in  the  majority  of  instances  in- 
obri'ety,  prostitution,  vagrancy  and  pauperism 
occur  in  persons  who  are  not  normal.  The  moral 
responsibility  of  the  mentally  defective,  whether 
insane,  feebleminded  or  epileptic,  cannot  be  con¬ 
sidered  the  same  as  the  normal;  yet  many  are 
sent  to  penal  institutions  owing  to  non-recogni¬ 
tion  of  their  mental  defect. 

Remember  that  the  feebleminded  may  be  adults 
physically  in  years  while  mentally  they  are  chil¬ 
dren  and  always  remain  such.  In  them  there  is 
a  cessation  of  mental  development  at  periods  cor¬ 
responding  with  perhaps  5,  6  or  7  years  in  the 
normal  child,  and  although  the  development  of 
their  physical  make-up  may  continue,  mentally 
they  remain  at  a  standstill.  In  consequence  of 
this  involvment  of  the  mental  state  these  persons 
are  unsocial  beings  incompetent  to  assume  a  nor¬ 
mal  position  in  a  community  by  maintaining 


themselves  or  to  enter  into  contracts  of  any  kind,, 
especially  that  of  marriage.  Why  should  per¬ 
sons  of  this  type  be  permitted  to  marry  and  bring 
into  the  world  others  of  their  kind  when  they, 
because  of  their  affliction,  cannot  even  care  for 
themselves  in  a  proper  manner  let  alone  caring 
for  others.  It  is  easier  and  more  economical  to 
maintain  a  feebleminded  woman  in  the  proper 
institution  than  to  maintain  later  a  numerous 
offspring. 

The  lack  of  mental  development  in  the  feeble¬ 
minded  and  the  failure  of  mental  powers  in  the 
demented  explains  why  in  these  persons  religious 
perversions  and  many  contrary  actions  take  place. 
In  an  early  stage  of  dementia,  before  the  mental 
failure  has  been  recognized  by  the  individual’s 
associates,  he  may  be  permitted,  as  a  result  of 
loss  of  control  over  natural  impulses  and  desires, 
to  fall  into  all  kinds  of  difflculties,  to  waste  his 
property,  to  abuse  alcohol  and  pass  into  excesses 
of  various  kinds,  especially  those  of  a  sexual 
nature.  The  average  person  does  not  realize  that 
in  most  defectives,  not  only  are  the  normal  pas¬ 
sions  of  man  present  but  in  many  they  are  exag¬ 
gerated  or  perverted,  and  at  the  same  time  the 
normal  control  which  man  may  have  over  such 
passions  is  either  markedly  impaired  or  entirely 
lost. 

Give  careful  consideration  to  the  fact  that  an 
exact  line  of  delimitation  between  the,  normal 
and  the  abnormal  mentally  cannot  always  be  ac¬ 
curately  drawn  and  in  consequence  there  are  con¬ 
siderable  numbers  of  individuals  who  may  within 
a  comparatively  short  period  from  the  time  they 
are  first  observed  pass  into  a  marked  state  of 
dementia  or  may  manifest  certain  symptoms 


17 


EPILEPTIC  IMBECILE. 

Actual  age,  14  years. 

Mental  age,  6  years. 

Esther  H. — 3557.  Admitted  to  Craig 
Colony  July  2,  1912.  Age  14  years.' 

Fourth  grammar  grade  education.  Pater¬ 
nal  grandmother  paralytic.  Father  alco¬ 
holic.  Mother  and  her  family  negative. 
Patient  fourth  in  family  of  seven,  all  liv¬ 
ing.  Onset  of  her  epilepsy  in  infancy. 
Infancy  and  childhood  of  patient  as  given 
normal  other  than  epilepsy.  Ran  away 
from  home  twice  at  age  of  13  years. 
Claimed  once  to  avoid  a  man  who  an¬ 
noyed  her.  Well  nourished,  good  looking 
girl.  Passed  Binet  test  at  six  years. 


i8 


EPILEPTIC  MORON. 

Actual  age,  20  years. 

Mental  age,  9  years. 

Jennie  T. — 3686.  Admitted  to  Craig 
Colony  Dec.  24,  1912.  American-born. 

One  year  high  school.  Maternal  grand¬ 
father  feeble-minded.  Father  alcoholic, 
sexually  immoral.  One  brother  feeble¬ 
minded.  Both  parents  died  of  tubercu¬ 
losis.  Personal  history  negative.  Onset 
of  epilepsy  at  12  or  14  years.  Alleged 
cause,  fall  from  piano  stool.  Probable 
cause,  puberty  in  a  pre-disposed  individual. 
Both  severe  and  mild  seizures,  one  or  two 
a  week. 


19 


EPILEPTIC  IMBECILE. 

Actual  age,  15  years. 

Mental  age,  7  years. 

Florence  M.  S. — 3672.  Admitted  to 
Craig  Colony  Nov.  23,  1912.’  Aged  15 
years.  American.  Mother  German.  Mother 
died  at  20  years  from  pulmonary  tuber¬ 
culosis.  Father  alcoholic.  Patient  had 
convulsions  during  first  dentition,  these 
continuing  at  varying  intervals  from  1  to  2 
daily  to  3  to  4  each  week.  Attended 
school.  Could  not  advance  beyond  2nd 
grade.  Passed  Binet  test  at  7  years.  'Was 
admitted  to  Colony  from  Detention  Home 
in  Buffalo,  where  she  iiad  been  committed 
for  wandering  on  streets. 


20 


EPILEPTIC  MORON.  SEXUALLY  IM¬ 
MORAL. 

Actual  age,  21  years. 

Mental  age,  10  years. 

Libbie  E.  J. — 3455.  Admitted  to  Craig 
Colony  Jan.  10,  1912.  21  years  of  age. 

High  school  education  (?''  American. 
Family  history  as  given,  negative.  Puny 
( ?)  baby.  Began  school  at  7  years,  making 
fair  progress.  First  epileptic  seizure,  prob¬ 
ably  grand  mal,  at  12  years.  No  cause 
assigned.  Since  then  seizures  recur  every 
two  or  three  weeks,  are  severe  and  occur 
in  'morning  as  a  rule.  No  history  of 
trauma.  Has  grown  stubborn  and  will 
not  obey  superiors.  When  admitted  she 
UiU  not  co-operate  well  during  examina¬ 
tion.  Passed  Binet  test  at  10  years. 
Shortly  after  admission  was  found  carry¬ 
ing  on  perverted  sexual  practices  with  an¬ 
other  female.  Repeatedly  attempted  to 
make  assignations  with  male  patients.  Is 
an  excellent  worker  in  cottage. 


21 


EPILEPTIC  MORON,  WITH  DEMEN- 
TIA. 

Actual  age,  38  years. 

Mental  age,  10  years. 

Ella  W. — 2794.  Admitted  to  Craig  Col¬ 
ony  June  10,  1910.  Aged  35  years. 

Widow.  German  descent.  Elementary 
education.  Made  poor  progress  in  school. 
Father  alcoholic,  mother  epileptic.  Twa 
sisters  and  her  own  son  epileptic.  Had 
to  use  braces  in  learning  to  walk.  Said 
to  have  been  run  over  by  a  wagon  at  age 
of  12  years.  She  has  been  hysterical  and 
threatened  suicide,  as  have  also  her  father 
and  son.  Has  had  delusions  that  she  was 
being  poisoned.  Alleged  age  onset  of  epi¬ 
lepsy  at  30  years,  and  assigned  cause  opera¬ 
tion  for  appendicitis.  Has  severe  seizures. 
Binet  test  made  February  8,  1913,  gave 
mental  age  as  10  years. 


22 


EPILEPTIC  IMBECILE. 

Actual  age,  46  years. 

Mental  age,  8  years. 

Stephen  B. — 1704.  Admitted  to  Craig 
Colony  Dec.  13,  1904.  Aged  37  years. 
American-born.  No  education.  Father 
said  to  have  had  convulsions.  Patient  had 
first  attack,  a  severe  one,  at  age  of  22 
years;  assigned  cause,  la  grippe.  Violent 
after  seizures.  Attended  school  from  age 
of  11  years  to  16  years,  but  made  no  prog¬ 
ress.  Married  at  age  of  27  years,  had 
one  child,  and  soon  after  wife  left  him. 
Upon  admission  he  was  a  well-nourished, 
muscular  individual  who  appeared  men¬ 
tally  deficient.  Could  not  name  state,  said 
he  was  born  in  1832,  could  not  name 
president,  said  he  voted  at  preceding  elec¬ 
tion  but  could  not  tell  for  whom  he  voted. 
Rudimentary  school  knowledge.  Binet- 
Simon  test  made  Feb.  7,  1913,  gave  his 
mental  age  as  8  years. 


23 


EPILEPTIC  MORON.  CRIMINALIS¬ 
TIC  (?). 

Actual  age,  18  years. 

Mental  age,  8  years.  '  ' 

Orin  S. — 2074.  Admitted  to  Craig  Col¬ 
ony  Oct.  19,  1906.  American-born,  as  also 
parents.  Mother  epileptic,  died  from  tuber¬ 
culosis,  as  also  paternal  great-aunt  and 
several  cousins;  patient  fifth  in  family  of 
six  children.  Infancy  and  childhood  nega¬ 
tive.  Reached  third  grade  in  school. 
Feeble-minded.  First  convulsion  occurred 
at  seven  years.  After  admission  was 
found  to  be  a  sexual  pervert.  Mischievous 
and  ran  away  from  institution  several 
times,  stole  chickens  from  neighboring  far¬ 
mers  and  money  from  other  boys.  etc. 
Mental  age  Feb.  11,  1913,  by  Binet-Simon 
test  was  8  years. 


•i 


24 


MORON.  VAGRANT.  EPILEPTIC. 

Actual  age,  20  years. 

Mental  age,  10  years. 

Arthur  T. — 1587.  Admitted  to  Craig 
Colony  Sept.  17,  1904.  Aged  11  years. 
Born  United  States.  Both  parents  alco¬ 
holic;  father  deserted  family.  Mother  in¬ 
sane  at  Buffalo  State  Hospital.  Patient 
second  of  three  children.  Early  history  of 

f)atient  unknown.  Age  at  onset  of  epi- 
epsy  alleged  to  be  eight  years;  severe 
seizures  recur  at  long  intervals.  Upon 
aamission  his  mental  state  was  noted  as 
feeble-minded.  A  Binet  test  made  Feb. 
10,  1913,  gave  mental  age  as  10  years.  It 
is  alleged  that  an  uncle  was  electrocuted 
for  murder  of  storekeeper  in  Rochester, 
1910.  Patient  has  repeatedly  run  away 
from  the  Colony,  apparently  because  of  a 
wani.ering  impulse. 


25 


MORON  EPILEPTIC. 

Actual  age.  20  years. 

Mental  age,  8  years. 

Charles  F.  C. — 1880.  Age  11  7-12  years. 
Father  died  at  29  years  from  tuberculosis. 
Both  grandfathers  alcoholic.  Two  paternal 
uncles  and  a  paternal  aunt  died  from 
tuberculosis.  Sister  of  patient  died  from 
convulsions  at  age  of  13  months.  Patient 
had  “light”  convulsions  during  teething. 
First  severe  convulsion  occurred  at  age 
of  4  years.  Have  recurred  weekly  and, 
again,  not  for  months.  Noted  as  feeble¬ 
minded  on  application.  Binet  test  made 
Feb.  11,  1913,  rates  his  mental  age  at  8 
years.  These  defectives  have  no  proper 
understanding  as  to  rights  of  property  or 
person. 


26 


EPILEPTIC  MORON. 

Actual  age,  26  years. 

Mental  age,  10  years. 

Walter  S.  H. — 3426.  Readmitted  to 
Craig  Coiony  Nov.  23,  1911.  Aged  26 
years.  Common  school  education.  Sin- 

fle.  Family  history  as  given  is  negative. 

irst  seizure  at  12  years.  Assigned  cause, 
injury  to  foot.  Probable  cause,  puberty. 
Grand  mal.  Hesitating  speech.  Usually 
■quiet  and  well  behaved.  Passed  Binet  test 
at  10  years. 


27 


which  show  that  they  are  not  of  a  normal 
make-up. 

The  treatment  of  these  various  defective  con¬ 
ditions  must  be  along  the  following  lines : 
Prophylactic  or  preventive,  ameliorative  and 
restorative  measures.  Under  the  prophylactic  or 
preventive  measures  must  be  considered  the  gen¬ 
eral  care  of  all  persons  in  a  community,  especially 
as  relates  to  a  living  wage,  so  that  dire  poverty 
will  not  exist.  The  environment  of  all  must  be 
made  such  that,  given  a  reasonably  healthy  make¬ 
up  to  start  with,  each  child  born  into  the  world 
may  develop  along  the  best  possible  lines.  In 
the  study  of  heredity  and  its  influence  one  must 
also  give  due  weight  to  the  effect  of  environment 
on  parents  and  offspring.  It  must  be  borne  in 
mind,  however,  that  with  important  elements 
required  for  development,  either  imperfect  or  de¬ 
stroyed,  that  the  best  environment  will  not  pro¬ 
duce  normal  individuals. 

The  individual  care  of  the  expectant  mother, 
of  the  infant  and  of  the  growing  child,  is  of  the 
most  vital  importance  from  every  viewpoint,  as 
are  also  the  regulation  of  the  diet  of  the  indi¬ 
vidual,  the  following  out  of  a  hygienic  way  of 
living  which  is  governed  by  rules  of  common 
sense  and  not  those  of  the  faddist.  Proper  school 
instruction  with  a  sufficient  amount  of  recreation 
and,  when  the  individual  reaches  the  proper  age, 
the  selecting  of  a  suitable  employment  must  be 
given  careful  consideration,  as  also  the  avoidance 
of  the  use  of  alcohol  with  the  beginning  of  early 
adult  years  and  through  the  balance  of  the  indi¬ 
vidual’s  life  and  so  far  as  possible  the  prevention 
of  injury  and  the  occurrence  of  disease  from  the 
moment  of  birth  throughout  life.  Many  of  these 
facts  are  matters  which  are  difficult  to  control. 


28 


but  which  must  receive  as  much  attention  as  is 
possible  under  given  circumstances. 

Medicines  are  of  value  in  treating  certain 
symptoms  especially  those  seen  in  the  epileptic 
and  the  insane,  but  the  use  of  quack  remedies 
which  oftentimes  are  most  damaging  in  their 
effects  to  the  person  taking  them  and  injurious 
to  his  pocket-book  as  well  as  those  of  his  rela¬ 
tives,  is  a  matter  which  should  constantly  be 
brought  to  the  attention  of  and  impressed  upon 
families  who  have  within  their  home  circle  an 
afflicted  one  who  might  be  induced  to  use  such 
remedies. 

Surgery  may  either  directly  or  indirectly  bring 
about  an  improvement  or  arrest  of  seizures  in  a 
few  cases  of  epilepsy  and  may  indirectly  im¬ 
prove  or  restore  to  a  normal  state  of  mind  some 
of  the  insane  but  beyond  this,  it  has  no  place  in 
the  treatment  of  these  conditions  except  as  might 
be  applied  to  any  person.  Be  skeptical  about  im¬ 
possible  claims  being  made  of  surgical  interven¬ 
tion,  e.  g.,  trephining,  nose  and  throat  work,  re¬ 
fraction  etc.,  curing  and  making  normal  a  per¬ 
son  primarily  defective  with  an  imperfect  brain. 

Persons  showing  feeblemindedness  or  the 
milder  forms  of  epilepsy  and  certain  forms  of 
insanity  may  sometimes  be  kept  at  home  where 
they  can  be  given  such  supervision  as  may  be 
necessary.  As  a  rule,  however,  the  great  ma¬ 
jority  of  these  mentally  afflicted  individuals 
must  ultimately  be  cared  for  in  some  kind  of 
an  institution,  public  or  private,  to  which  they 
should  be  legally  committed  as  are  the  insane. 
The  antagonistic,  critical,  unreasonable,  and 
fault  finding  attitude  sometimes  assumed  by 
the  relatives  of  a  defective  toward  the  institu¬ 
tion  or  those  seeking  to  provide  proper  care 


29 


for  the  afflicted  one  is  due  to  ignorance  or  to 
the  fact  that  relatives  are  also  defective  and 
cannot  grasp  the  situation. 

There  is  a  great  necessity  for  pushing  every 
means  of  educating  the  general  public  and  es¬ 
pecially  the  relatives  of  those  afflicted  in  regard 
to  preventive  measures  and  where  an  individual 
has  been  restored  to  a  normal  state  of  mind, 
pertaining  to  the  after  care  which  is  necessary 
to  prevent  a  recurrence. 

The  discipline  acquired  by  proper  care  in  an 
institution  will  oftimes  enable  the  afflicted  in¬ 
dividual  to  live  quite  comfortably  in  an  institu¬ 
tion  when  no  hope  can  be  held  forth  that  a  com¬ 
plete  arrest  of  symptoms  will  result  so  that  the 
person  can  return  to  the  life  of  the  outside 
world.  It  has  been  suggested  that  ultimately 
it  may  be  possible  to  have  defectives  not  in  in¬ 
stitutions  visited  regularly  in  their  homes  by  rep- 
sentatives  of  the  state. 

School  work  for  defective  children  requires 
careful  planning  in  order  that  any  satisfactory 
results  may  be  obtained.  A  comparatively  small 
percentage  of  defectives  are  able  to  carry  along 
the  ordinary  branches  of  the  school  work  to  the 
extent  of  the  work  done  in  the  higher  gram¬ 
mar  or  high  school  grades.  The  bulk  of  educa¬ 
tion  given  to  defectives  should  be  along  simple 
lines  and  especially  the  manual  branches  which 
will  enable  these  afflicted  persons  to  frequently 
become  adept  to  such  a  degree  as  to  enable  them 
to  be  of  material  assistance  in  the  life  of  the 
community  in  which  they  reside. 

It  must  be  remembered  that  with  the  epileptic 
special  perseverence  is  required  because  of  the 
fact  that  many  of  them  have  blotted  out  by  a 
seizure  the  instruction  which  has  just  been  given, 


30 


this  necessitating  repeating  the  teaching  a  great¬ 
er  number  of  times  than  is  necessary  for  the  or¬ 
dinary  person,  who  is  not  an  epileptic.  It  goes 
almost  without  saying  that  tact  on  the  part  of 
the  teacher  is  more  necessary  with  the  defec¬ 
tive  than  with  the  ordinary  child. 

The  relation  of  the  adult  defective  to  society 
is  an  exceedingly  important  matter.  Such  de¬ 
fectives  if  allowed  to  assume  the  responsibility 
of  parenthood  either  by  being  legally  married 
or  by  mating  or  cohabiting  without  the  mar¬ 
riage  ceremony  results  in  a  defective  progeny, 
which  cannot  maintain  itself  as  normal  persons 
should,  becoming  a  burden  on  those  relatives 
who  are  able  to  assume  a  more  or  less  normal 
place  in  the  community  or  becoming  entirely 
dependent  on  the  community.  It  must  be  re¬ 
membered  that  especially  with  the  epileptic  who 
is  thus  permitted  to  assume  the  responsibility  of 
parenthood  that  as  time  goes  on  deterioration 
occurs  in  the  majority  of  instances  and  there 
presents  itself,  the  problem  of  not  only  caring 
perhaps  for  several  defective  offspring,  but  also 
caring  for  the  defective  person  himself  or  her¬ 
self. 

It  is  a  much  more  common  occurrence  to  have 
the  female  ^defective,  either  taken  advantage  of 
or  even  married  legally  by  a  normal  male,  by  one 
who  approaches  the  normal  or  by  a  medium 
grade  defective,  than  it  is  for  a  defective  male 
to  be  associated  with  the  normal  female.  This 
being  true,  it  is  necessary  that  the  female  de¬ 
fective  be  more  closely  watched  over,  especially 
during  the  child  bearing  age,  than  the  male  de¬ 
fective.  This  should  not  preclude  the  necessity 
of  also  having  the  male  defective  under  super¬ 
vision  as  in  certain  ways  he  is  more  prone  per- 


31 


haps  to  develop  tendencies  which  in  themselves 
are  not  a  benefit  to  those  about  him,  e.  g.  the 
abuse  of  alcohol,  stealing,  making  assaults,  sex¬ 
ual  and  ordinary,  destroying  property,  etc.  We 
quarantine  for  a  brief  period  those  persons  suf¬ 
fering  from  infectious  diseases;  why  not  quar¬ 
antine  for  life  those  who  are  always  a  menace 
to  their  neighbors. 

Many  have  advocated  sterilization  of  defec¬ 
tives  by  various  methods,  in  some  of  which  the 
essential  sexual  organs  are  'entirely  removed  so 
it  is  impossible  for  a  person  thus  operated  upon 
to  procreate ;  in  others  an  operation  is  performed 
to  prevent  the  substance  peculiar  to  the  sex,  be 
it  ovum  or  spermatozoon,  from  passing  through 
the  normal  channel  to  unite  with  that  from  the 
opposite  sex,  but  permitting  the  special  internal 
secretion  of  the  sexual  glands  to  pass  into  the 
system  of  the  individual.  General  sterilization 
of  defectives  will  never  be  practicable  for  self- 
evident  reasons. 

Defectives  who  have  been  sterilized  are  still  a 
menace  to  the  community,  notwithstanding  state¬ 
ments  to  the  contrary,  as  such  operations  do  not,, 
in  the  majority  of  instances,  diminish  the  sexual 
desires  of  these  individuals  to  the  extent  thought 
by  the  public.  If  permitted  to  have  their  liberty 
in  the  community,  females,  especially  the  morons,, 
who  have  been  thus  operated  upon  will  undoubt¬ 
edly,  in  the  great  majority  of  instances,  become 
common  characters,  contaminate  children  and 
distribute  broadcast  venereal  disease,  especially 
syphilis,  in  consequence  of  which  a  great  amount 
of  harm  will  be  done  to  the  community. 

Males  who  have  been  operated  on,  unless  made 
complete  eunuchs  are  also  exceedingly  danger¬ 
ous  to  the  community,  as  they  can  still  commit 


32 


sexual  assaults,  which  unfortunately  are  fre¬ 
quently  perpetrated  on  innocent  young  girls.  It 
is  well  known  that  perverted  sexual  acts  are 
commonly  practiced  by  defectives,  so  that  boys 
are  not  safe  from  this  class.  This  phase  of  the 
question  of  sterilization  is  one  which  some  writ¬ 
ers  scoff  at  as  being  immaterial  and  not  of  much 
consequence,  but  I  wish  to  make  a  protest  against 
the  idea  being  held  that  because  sterilized  it  is 
perfectly  safe  t#  turn  such  a  defective  loose  in 
the  community. 

To  my  mind  the  best  method  for  meeting  this 
problem  of  defectiveness  is  that  of  segregation. 
Segregation  means  the  placing  of  these  defectives 
in  a  community  by  themselves  where  they  live 
with  their  kind,  and  are  educated  to  the  extent 
that  their  mental  state  will  permit.  They  are 
given  the  necessary  medical  care  that  their  health 
demands  and  they  are  allowed  every  liberty 
which  can  be  consistently  granted.  The  result 
of  such  community  life  for  the  defective  is  that 
ordinarily  they  become  contented  and  satisfied, 
feeling  that  they  have  a  place  in  this  special 
community,  something  which  they  could  not  have 
in  the  ordinary  community  in  the  outside  world. 

The  ideal  method  of  segregation  is  that  of  the 
colony  plan,  where  the  institution  is  arranged 
along  the  same  lines  as  that  of  a  large  village, 
having  its  own  means  of  recreation  and  occupa¬ 
tion  as  well  as  the  buildings  for  proper  housing 
and  otherwise  caring  for  its  inmates.  It  has  been 
well  said  that  good  material  cannot  be  made  out 
of  bad  material,  but  fairly  good  material  may  be 
spoiled  by  bad  environment.  This  truism  is  fre¬ 
quently  forgotten.  There  is  a  great  amount  of 
evidence  to  show  that  even  though  an  individual 
is  permanently  defective,  a  change  to  a 


33 


proper  environment  will  bring  about  a  material: 
improvement  in  the  general  condition  of  such 
person.  If  this  change  in  environment  can  for¬ 
tunately  be  brought  about  in  early  life,  the  de¬ 
velopment  is  not  infrequently  aided  to  such  a 
material  extent  that  the  defective  child,  when  the 
adult  period  has  been  reached,  becomes  a  help¬ 
ful  part  of  the  family  or  household  in  which  he 
is  residing,  although  perhaps  his  mental  state  is 
not  sufficiently  normal  as  to  ma^e  him  self-sup¬ 
porting. 

St.  Paul  tells  us,  in  his  Epistle  to  the  Thessa- 
lonians,  “comfort  the  feebleminded.”  This  ad¬ 
vice  if  carried  out  in  a  broad  sense,  is  all  that  can 
be  done  for  this  class  of  individuals.  They  can¬ 
not  be  made  normal,  as  there  is  a  permanent 
damage  to  their  central  nervous  system,  some¬ 
thing  which  cannot  be  restored  by  any  human 
means.  Recognizing  this  permanent  defect,  it 
seems  a  preposterous  thing  to  send  such  irre¬ 
sponsible  persons  to  reform  schools,  prisons,  etc., 
with  the  idea  of  making  them,  after  a  few  years" 
residence,  perfectly  normal  persons  to  be  restored 
to  a  free  and  unrestrained  life  in  the  outside 
world. 

In  considering  the  enactment  of  legislation  re¬ 
lating  to  the  problem  of  defectiveness,  conser¬ 
vatism  must  be  ever  before  us,  this  to  be  tinged 
with  a  considerable  degree  of  optimism.  The 
task  of  solving  this  problem,  in  part  at  least,  is 
not  entirely  hopeless.  I  do  not  contend  that  we 
can  ever  hope  entirely  to  remove  the  defective 
from  our  midst,  nor  would  it  perhaps  be  desir¬ 
able,  but  I  do  maintain  that  it  is  possible  by  the 
use  of  unobjectionable  means  to  ultimately  place 
the  great  proportion  of  the  defectives  under 
such  a  kindly  supervision  as  to  prevent  them 


34 


from  increasing  their  kind  and  from  producing 
in  the  ordinary  community  damage  by  unsocial 
acts. 

Many  of  the  hasty,  ill-advised  measures  ad¬ 
vocated,  perhaps  by  inexperienced  theorists,  are 
not  only  futile  but  are  injurious  to  the  cause  of 
providing  proper  care  for  this  class.  It  must  not 
'be  forgotten  that  at  no  time  can  we  ever  hope 
to  have  restrictive  measures,  whether  they  be 
custodial  laws,  marriage  laws,  laws  of  preven¬ 
tion  of  procreation,  etc.,  that  will  include  all 
who  can  properly  be  called  defective.  A  certain 
proportion  of  defectives  may  be  brought  within 
the  influence  of  custodial  legislation  but  a  vast 
number  of  the  higher  grade  of  defectives  can¬ 
not  possibly  be  reached  until  there  is  aroused 
public  opinion  to  the  fact  that,  not  only  is  it  a 
kindness  to  the  individual,  but  also  a  duty  to  the 
public  at  large  to  have  such  high  grade  defec¬ 
tives  under  proper  supervision  at  all  times.  This 
means  that  provision  must  always  be  available 
for  voluntary  inmates  in  our  various  institutions 
for  the  subnormal  and  abnormal,  and  perhaps 
when  a  Utopia  is  with  us,  all  of  these  will  re¬ 
ceive  special  care  and  supervision.  For  the 
higher  grade  defectives,  especially  for  those  who 
approach  closely  the  normal,  however,  this  care 
is  something  in  the  future,  as  the  matter  of  mak¬ 
ing  a  positive  diagnosis  of  defectiveness  in  this 
type  will  naturally  always  meet  with  much  crit- 
i''ism  and  objection  on  the  part  of  the  general 
public. 

Well  thought  out  laws  relative  to  the  care  of 
the  insane,  the  inebriate,  the  epileptic,  the  feeble¬ 
minded,  including  with  the,  latter  the  vagrant, 
a  large  percentage  of  the  prostitutes,  etc.,  must 
be  given  the  utmost  consideration  by  all  who  are 


35 


interested  in  the  welfare  of  humanity.  The 
question  of  deciding  as  to  mental  competency 
or  incompetency  of  the  higher  grade  defective 
is  something  that  requires  the  most  careful  ex¬ 
amination  and  consideration.  Until  there  is 
aroused  a  public  conscience  with  a  well  defined 
moral  sense  at  the  fore  we  can  not  expect  to 
accomplish  much  as  to  the  control  of  venereal 
disease  and  the  enforcement  of  marriage  laws. 
So  long  as  there  is  a  double  moral  standard  for 
the  sexes  just  so  long  will  many  of  these  condi¬ 
tions  continue  to  exist.  There  must  be  eradica¬ 
ted  false  ideas  held  regarding  the  necessity  for 
“the  sowing  of  wild  oats/’  i.  c.,  incontinence  of 
males.  We  must  remember  that  laws  will  not 
make  all  persons  moral.  There  must  be  some¬ 
thing  more  before  what  we  desire  in  this  direc¬ 
tion  can  be  accomplished. 

Health  certificates  before  marriage  may  in 
many  instances  prevent  those  having  venereal 
disease,  either  syphilis  or  gonorrhea,  in  the  in¬ 
fective  stage,  from  marrying,  but  from  the 
standpoint  of  heredity  such  certificates  cannot 
at  present*  be  of  great  value  for  the  reason  that 
so  far  as  the  vast  majority  of  mankind  is  con¬ 
cerned  the  facts  relative  to  heredity  are  not 
available. 

Unfortunately,  it  is  a  well-known  fact  that 
in  many  instances  a  person  of  some  means  can 
seemingly  evade  any  law,  no  matter  what  it 
may  be;  and  another  thing  to  remember,  so  far 
as  the  sexual  relations  are  concerned,  is  that  no 
law  can  override  sentiment,  nor  would  it  be 
well  to  have  the  world  ever  come  to  such  a  state 
that  what  we  recognize  as  the  normal  feeling  of 
affection  between  a  man  and  a  woman  who  en¬ 
ter  the  marriage  state  should  be  lacking  and 
36 


when  those  desiring  to  become  such  partners 
should  simply  be  picked  out  by  the  state  from 
a  standpoint  as  to  whether  or  not  they  were 
perfectly  healthy.  In  our  day  certain  writers 
go  so  far  as  to  advocate  the  sweeping  away  of 
the  home,  marriage .  and  morality.  This  being 
true  of  people  supposedly  above  the  average  in 
intelligence,  what  can  such  an  example  mean  to 
the  masses.  Transitory  matings  of  the  type  ad¬ 
vocated  would  soon  result  in  the  undoing  of  the 
race  as  there  would  be  no  restriction  of  the  pas¬ 
sions  of  man. 

It  is  my  opinion  that  proper  control  of  the 
sexual  instinct  is  not  to  be  obtained  by  constant 
detailed  harping  on  the  subject  in  schools,  which 
often  results  in  developing  in  children  morbid 
ideas  regarding  the  subject,  for  intimate  knowl¬ 
edge  alone  of  such  matters  has  never  proved  a 
means  of  preventing  man  from  permitting  his 
sexual  instinct  from  controlling  him  instead  of 
his  being  its  master.  In  fact,  the  contrary  has 
been  too  often  the  case.  There  must  be  incul¬ 
cated  in  young  and  old  the  fact  that  the  human 
individual  exists  for  other  reasons  than  satisfy¬ 
ing  every  appetite,  powerful  though  such  may 
be.  All  must  learn  that  continence  and  health 
are  entirely  compatible  although  some  would  try 
to  prove  the  contrary.  The  arousing  of  diverse 
interests  in  other  matters,  and  from  an  early 
age  the  developing  of  self-control  in  the  indi¬ 
vidual  as  relates  to  all  desires,  are  of  funda¬ 
mental  importance,  controlling  and  directing  the 
various  instincts  along  proper  channels. 

In  conclusion,  I  would  repeat  that  all  inter¬ 
ested  in  the  welfare  of  the  race,  who  give  careful 
thought  to  the  facts  and  knowledge  at  present 
available  regarding  defectiveness  must  concede 


37 


that  all  we  can  accomplish  at  present  is,  so  far  as 
possible,  to  segregate  those  who  because  of  de¬ 
fective  make-up  are  incompetent  to  assume  a 
normal  place  in  the  community,  and  in  accom¬ 
plishing  this  protect  both  the  defective  individual 
and  the  community.  Such  partial  segregation  is 
worth  while  and  is  in  the  last  analysis  economi¬ 
cal.  Marriage  laws,  sensible  in  nature,  will  ac¬ 
complish  something;  but  in  order  to  have  any 
marriage  law,  no  matter  how  good,  enforced,  it 
will  be  necessary  to  carry  on  an  active  educa¬ 
tional  campaign  for  a  considerable  period  before 
the  general  public  will  assist  in  such  enforce¬ 
ment.  They  must  realize  what  venereal  disease 
means,  what  mental  defect  means,  what  the 
responsibility  of  parenthood  means,  and  must 
be  given  the  results  of  a  long-continued,, 
thorough  study  regarding  hereditary  influ¬ 
ences  before  we  can  hope  to  secure  their  ac¬ 
tive  co-operation  to  meet  the  problem  of  de¬ 
fectiveness. 

Sterilization  has  its  place  in  selected  cases, 
but  I  wish  to  reiterate  the  fact  that  even  though 
when  practicable,  a  defective  person  may  be 
sterilized,  it  is  not  safe  to  turn  such  an  individ¬ 
ual  loose  in  the  community. 

Enthusiasts  will,  unless  held  in  check,  simply 
confuse  the  issue  at  hand.  A  wise  conserva¬ 
tism,  especially  by  physicians,  is  demanded  if 
anything  lasting  is  to  be  accomplished  in  the 
matter  of  the  prevention  of  defectiveness.  It 
is  well  established  that  all  families  and  all  na¬ 
tions  pass  through  a  cycle  of  existence  or  life, 
as  does  the  human  individual.  Defectiveness 
can  never  be  controlled  but  in  part. 

The  cost  of  segregating  a  considerable  pro¬ 
portion  of  defectives  will  be  no  small  sum,  but 

38. 


think  of  the  amounts  of  money  wasted  annually 
on  alcoholic  beverages  and  in  dissipation  of  one 
kind  or  another,  so  common  to  our  day,  factors 
which  also  increase  the  number  of  defectives. 
If  but  a  part  of  the  amount  so  expended  was 
made  available  the  problem  of  meeting  the  ex¬ 
pense  of  providing  adequate  means  of  segre- 
:gation  could  be  easily  met.  Until  the  people 
realize  the  relationship  between  mental  defec¬ 
tiveness  and  crime,  pauperism,  inebriety,  vag¬ 
rancy,  prostitution,  etc.,  there  will  not  result  the 
strict  but  kindly  segregation  advocated  as  the 
solution  of  the  problem  of  caring  for  defectives. 


^9 


BROOKLYN  EAGLE  PRESS 


